MEDICARE: NORTH CENTRAL IOWA MENTAL HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07466	OTHER	IA	WELLMARK BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588926448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL IOWA MENTAL HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	720 KENYON RD
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5759
Country	:	US
Telephone Number	:	800-482-8305
Fax Number	:	515-573-7898

Provider Business Practice Location Address
First Line	:	1890 E MAIN ST
Second Line	:
City	:	LAKE CITY
State	:	IA
Zip	:	51449-7706
Country	:	US
Telephone Number	:	712-464-8961
Fax Number	:	712-464-3326

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	AARON D MCHONE
Credential	:
Telephone Number	:	800-482-8305

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	11/30/2018

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